Organization
MSM HOLDCO, LLC
Active
Organization
MSM HOLDCO, LLC
Active
Other names
Martin's Pharmacy #2322, Martin's Pharmacy #22, Martin's Super Market Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ELLIS RPH (DIRECTOR OF PHARMACY)
(616) 878-2848
Entity
Organization
Contact information
Practice address
865 E JEFFERSON ST, PLYMOUTH, IN 46563-1847
(574) 936-7334
(866) 528-5774
Mailing address
1527 MOMENTUM PLACE, CHICAGO, IL 60689-5315
(616) 878-8584
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60005667A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200377010A
—
IN
Enumeration date
11/03/2006
Last updated
05/07/2024
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